阿兹夫定与奈玛特韦/利托那韦治疗COVID-19的比较:基于倾向性评分匹配真实世界回顾性研究  

Comparison of azvudine and nirmatrelvir/ritonavir in the treatment of COVID-19:a propensity score matching real-world retrospective study

作　　者：肖云[1] 阳胜 汪洋[2] 谭重庆[3] 朱娅琳 朱芷若 肖奎[1] Xiao Yun;Yang Sheng;Wang Yang;Tan Chongqing;Zhu Yalin;Zhu Zhiruo;Xiao Kui(Department of Pulmonary and Critical Care Medicine,the Second Xiangya Hospital,Central South University,Changsha 410011,China;Department of Pathology,the Second Xiangya Hospital,Central South University,Changsha 410011,China;Department of Pharmacy,the Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院呼吸与危重症医学科,长沙410011 [2]中南大学湘雅二医院病理科,长沙410011 [3]中南大学湘雅二医院药学部,长沙410011

出　　处：《国际呼吸杂志》2024年第8期884-892,共9页International Journal of Respiration

基　　金：湖南省自然科学基金(2021JJ30963);湖南省卫生健康委科研计划项目(202103020704);国家临床重点专科建设项目。

摘　　要：目的:基于倾向性评分匹配(PSM)比较阿兹夫定与奈玛特韦/利托那韦对新型冠状病毒感染患者住院和随访期间的临床疗效及治疗结局。方法:本研究为回顾性真实世界队列研究。采用非随机抽样法,收集2022年12月7日至2023年1月31日在中南大学湘雅二医院住院的新型冠状病毒感染患者的病例资料,根据所用抗病毒药物分为阿兹夫定组(A组,307例)和奈玛特韦/利托那韦组(P组,426例),采用PSM平衡2组间患者基线特征差异所造成的混杂偏倚。经1∶1 PSM后,A组和P组各261例纳入分析。比较2组患者在综合结局发生率、全因死亡率、重症监护病房入住率、机械通气率、高流量氧疗率、住院时间、入住重症监护病房时间和住院费用等方面是否存在差异。对患者进行电话随访,追踪长新冠症状并统计再次感染和死亡情况。结果:A组中男169例(64.75%),女92例(35.25%),年龄(68.07±14.19)岁;P组中男178例(68.20%),女83例(31.80%),年龄(68.69±15.97)岁。A组的住院费用低于P组[12892.48(7287.02,21763.97)元比17105.47(10926.37,33027.88)元,U=5.02,P<0.010];2组患者在综合结局发生率、全因死亡率、重症监护病房入住率、机械通气率、高流量氧疗率、住院时间和入住重症监护病房时间方面差异均无统计学意义(均P>0.05)。患者于1、3、6个月时进行电话随访,2组患者1个月、3个月、6个月时全因死亡率差异均无统计学意义(均P>0.05)。随访中2组共54例(11.49%)患者报告了新型冠状病毒再感染[A组24例(10.21%),P组30例(12.77%),χ^(2)=0.75,P=0.390],再感染的症状较初次无加重。有117例(24.89%)患者报告了长新冠症状[A组53例(22.55%),P组64例(27.23%),χ^(2)=1.38,P=0.241],常见的长新冠症状包括乏力(9.79%,46/470)、气促(5.74%,27/470)及咳嗽咳痰(3.19%,15/470)。结论:在新型冠状病毒感染住院患者中,接受阿兹夫定抗病毒治疗患者的住院费用较奈玛特韦/利托那韦患者低,2种Objective To evaluate the efficacy and clinical outcomes of azvudine(group A)and nirmatrelvir/ritonavir(group P)in patients with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection during hospitalization and follow-up by the propensity score matching(PSM).Methods This was a real-world retrospective cohort study.Clinical data of the coronavirus disease 2019(COVID-19)patients hospitalized in the Second Xiangya Hospital of Central South University from December 7,2022 to January 31,2023 were collected by a non-random sampling.Patients were categorized into the group A(n=307)and group P(n=426)based on the use of antiviral SARS-CoV-2 drugs.PSM was used to balance the confounding bias arising from variations in baseline characteristics between groups.After PSM at a ratio of 1∶1,261 cases in group A and 261 cases in group P were recruited.The incidence of overall outcomes,all-cause mortality,admission rate in intensive care unit(ICU),proportion of mechanical ventilation,proportion of high-flow nasal cannula therapy(HFNC),length of stay,length of ICU stay,and hospitalization costs were compared between the two groups.The patients were followed up by telephone to track the long COVID symptoms,SARS-CoV-2 reinfections and deaths.Results There were 169 males(64.75%)and 92 females(35.25%)in group A,with a mean age of 68.07±14.19 years.There were 178 males(68.20%)and 83 females(31.80%)in group P,with a mean age of 68.69±15.97 years.The total hospitalization cost of group A was significantly lower than that of group P(12,892.48[7,287.02,21,763.97]yuan vs 17,105.47[10,926.37,33,027.88]yuan,U=5.02,P<0.010).There were no significant differences in the incidence of overall outcome,all-cause mortality,admission rate of ICU,proportion of mechanical ventilation,proportion of HFNC,length of stay,and length of ICU stay between the two groups(P>0.05).Patients were followed up by telephone at 1,3,and 6 months,and there was no significant difference in the all-cause mortality(all P>0.05).During the follow-up,54 patient

关 键 词：新型冠状病毒感染 阿兹夫定 奈玛特韦/利托那韦 抗病毒治疗 临床疗效 倾向性评分匹配 真实世界研究 

分 类 号：R511[医药卫生—内科学]